MoH revising directive to punish Scholarship Students

After completing my MBBS studies under government scholarship at KIST Medical College, I joined Charikot Primary Health Care Centers(PHCC) under government’s contract two months back.

 Nepal’s rural health care delivery system relies hugely on doctors like me who studied on scholarship. Each doctor studying under Ministry of Education’s scholarship has to serve 2 years under government contract of which 1 year has to be in a rural setting. Currently over 400 doctors who studied under scholarship are working in 200 plus Primary Health Care Centers (PHCCs) across the country.  They represent over 70% of all doctors in PHCCs. PHCCs are often located in remote setting making these under contract doctors backbone of our rural health care.

This however comes at a hefty cost. 1) We are barred from pursuing any professional courses (MD/MS) in these two years. 2) The salary is nominal - I currently work in Charikot PHCC run jointly by Nepal Govt and an INGO -possible health. The medical officers from the INGO make 3 times as much as I do.   3)We get 30 days off in year – 2.5 days per month which gives one no family time because for many of us getting to our workplace takes more that.  

The ministry of health (MoH) is now working to revise directives pertaining to dissemination doctors who studied under scholarship. Increasing the contract duration from 2 to 5 years is a popular stance in the ministry.   They are spreading myths, redefining scholarship to introduce new directive that will  jeopardize careers of students who studied under scholarship while the people & government get little to no benefit.  

Spreading myths: 40 lakh worth of scholarship

No, the government doesn’t spend 40 lakhs . First the government doesn’t even spend a penny in our fees.  All private medical colleges have 10% seats reserved for scholarships, because a 10% increase in students adds insignificant operational cost to the institutes.  

Second, the price is hugely inflated to benefit the private colleges. A team lead by Dr.Bhagwan Koirala determined the fees to be Rs.38,50,000 for public institutes like IOM with 50% seats reserved for scholarships effectively cutting the 40 lakh figure to half. A public institute like IOM pays has significantly higher number of academic staffs and also pays these staffs double of what private medical colleges do.  Hence, The cost of MBBS in private institute is hence significantly lower.

The government paying hefty fees with poor man’s taxes is a hoax perpetrated by the MOH and local leaders alike to make us feel unnecessarily indebted and justify MOH harsh directives for scholarship students.

 Government’s loss

The health care system will get nothing extending the contract, except crowding PHCCs with huge numbers of frustrated doctors. The number of doctors in PHCCs is already thrice the sanctioned post. The condition is so bad that MOH exhausted its finances allocated for paying salaries of these staffs this year. We have not received salaries for months.

Increasing the contract will increase the number of doctors by nearly 3 folds. That’s taxpayer’s money wasted on unnecessary human resource over essential facilities – like measuring serum glucose – and only 7% of the PHCCs(and only 20% of district hospitals) have lab facilities to measure serum glucose. 

Also, barring Nepal’s top graduate from pursuing their education will also weaken our academic institutes.

Redefining scholarship as Investment

Getting a MOE scholarship or an admission in Institute of Medicine/BPKIHS used to be a matter of pride because they were academic scholarship handed to the best. Academic institutions all across the globe reward outstanding students with scholarships and expect nothing in return except maintaining the outstanding record.

However, our Ministry of Health (MoH) has always defined our scholarships as an investment and our contract duration as return.

The MOH has been very clear that we have to pay it back. With limited benefit to our healthcare system we are paying it back with our careers just for the sake of paying it back as if our scholarship was a loan. This attitude from the MOH makes us feel like we are being punished for being outstanding students.

Jeopardizing careers

Working 5 years under MOH’s harsh contract will have catastrophic impact not just our careers but also family and social life. Unable to join MD/MS program after 5 years is frowned upon in medical field. Also one’s ability to learn new skills fades with time – joining post graduate program at age of 30-35 years will shape the once best students of the country into only mediocre clinicians.

Dr. Bishal Gyawali, who is now one of the most renowned oncologist in the world, graduated from IOM in 2012 and finished his PhD within 5 years of that. Imagine where he would have been if he was tied down like rest of us.  Since 2016, all IOM graduates have 2 years of mandatory government contract where they are barred from studies. Now, it could be 5. Ridiculous!


Opportunity
Introducing a new directive is also an opportunity for MOH to design a contract that respects our efforts.
No doctor should be barred from pursuing a post graduate degree during the contract. If paying back for the scholarship is important for MOH, one could be asked to complete it after PG. Also, increasing the duration of the contract is unnecessary not cost effective.

We should not be punished for studying under scholarships.

The story was published on MyRepublica on 2018/01/03 - A doctor's complaints
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